1. MohammedAli,MPH-HealthProgramManager,CRSGhana
PresentationforUSAIDWashington
July20,2016
1
Adopting Healthy Maternal
and Child Survival Practices
in Rural Ghana

2. 2
Outline:
• Introduction
• The Problem
• Approaches
• Outcomes
• Sustainability
• Challenges

3. Introduction
3
• Title: Encouraging Positive
Practices for Improving Child
Survival (EPPICS)
• Goal: To contribute to sustainable
maternal/newborn
morbidity/mortality reduction by
2015
• Partner: Ghana Health Services
• Location: East Mamprusi District
• Targets: 27,000 Women of
Reproductive Age and 24,000
Children under 5 years of age
East
Mamprusi

4. The Problem Analysis
4
Baseline MCH Indicators
District, Region and National- 2010/11
East
Mamprusi
Northern
Region
Ghana
Antenatal
visits (1st
trimester)
30 49 55
Antenatal
visits(4+)
46 58 78
Supervised
deliveries
43 38 46
IPT2+
51 33 44
ITN use 36 45
Institutional
MMR
275 95 68
Under 5
Mortality
Rate
138 137 80
Poor uptake of MCH
services → High Maternal
and Child morbidity and
mortality
Low Government capacity
→poor service delivery
Poor community
engagement→ low
patronage of services

5. 5
Strategies Deployed
.
• 15 -25 mothers CU2 or PW
• Behavior change educational
sessions
• Facilitated by Model Mothers
• Bi-monthly Meetings
• Home visits
• 5 -7 leaders custodians of
traditions and culture
• Repositioned as Council of
Champions for MCH
• Worked to modify pervasive social
norms
• Engaged to influence Household
Decision Makers
5
Council of Champions
Community Pregnancy
Surveillance & Education Sessions

6. 6
Strategies to improvereferrals/access
Modified Motor-Tricycle (MMTs)
 MMT improved access to MCH services
 Established 7 management Committee
 Trained and provided logistics to MMT
drivers
Repositioning TBAs as Link Providers
 Active TBAs identified/repositioned
 Referred pregnant women to health
facilities
 Conducted home visits
 Supported transport emergency cases
to health facilities

7. 7
Strategiesto improvequality
.
 Motorbikes/fuel for outreach
 Basic medical equipment
 Supplies
 Mobile phones
• 12 Health Facilities
• Quality Improvement Cycles
• Emergency Obstetric Care
• Essential Newborn Care
• Lactation Management
7
Training/Mentoring/Coaching
Provision of Equipment and Supplies

8. 8
CommunityLedMonitoring,EvaluationandLearning
WallsofGoodHealth
. .
8
 Community managed MEAL tool
 Displays two key MCH indicators
 Managed by 7 member
committee
 Uses color and score sticks to
provide monthly updates on
progress of various selected
indicators

9. Fixing the Problem:
Partnership with the Government and MoH was key
9

10. CRS Partnership with Government – the Process
•Joint:
•Design
•Planning
•Implementation
•Monitoring and Supportive
Supervision
Collaborative
•Technical Capacity
•Transferring Funds
•Materials &Equipment
Supportive
•Implementation
•Monitoring, Evaluation and
Learning sessions
•Shadowing
•Mentoring/Coaching
Accompaniment
10

11. Timelines for Transfer of Responsibility to MoH
Project Year
• MoH/GHS
Role
• CRS Role
• Milestone
1
• Train
Health
Staff on
MCNH
topics
• Technical
Expert
• Capacity
strengthen
ing
2
• Mentee
• Mentor
• Skilled
Health
staff lead
stepdown
trainings
3
• Practitioner
• Supportive
supervisor
• Incremental
transferring
of
responsibility
4
• Provides
technical
support to
other districts
• Consultant
• Complete
transfer of
responsibility
11

12. Impact: Mortalitybased Indicatorsfrom2010-2015
• .
12
2010 2011 2012 2013 2014 2015
Institutional Maternal Mortality Rate 275 131 76 47 57 81
Infant Mortality Rate 62 44 25 19 13 13
Neonatal Death Rate 7 8 5 5 4 3
0
50
100
150
200
250
300
Percentage
Figure. Indicators of Mortality
Source:GHS- 2015AnnualHealthPerformancereviewreportforEastMamprusi.

13. Partnership between CRS and MoH: the QuicksGains
• Communities collaborating with health
facilities
• Community Emergency Transport
Committees established/strengthened
• Healthy Mothers and Newborn Care
Committees established & functioning
240
• Traditional Birth Attendants Repositioned
as Link Providers
• Model Mothers delivering MCH messages
to households members
480
• Quality Improvement teams functioning in
all health facilities
• Health facilities enhanced supply of basic
maternal and child medical equipment
12
13

14. Key Outcomes-Maternal& NewbornCare -60% LOE
• Baseline/End line Key indicators:
• Use of ANC within 1st Trimester ↑ from 50% to
74% (p<0.001)
• Four Plus ANC uptake ↑ from 63.9% to 82%
(p<0.001)
• Skilled Assisted Deliveries ↑ from 43% to 77%
(p <0.058)
• Clean Cord Care ↑ from 22% to 73% (p <0.001)
• Postnatal Care within 48hrs ↑ from 32% to 84%
(p<0.001)
•Source: EPICs KPC, 2015
109% Reduction in
Institutional Maternal
Mortality Ratio
131%↓ in infant Mortality
Ratio
80% Reduction in Neonatal
Mortality Ratio
Source: GHS - 2015 Annual Health Performance
review report for East Mamprusi
14

15. Key Outcomes– NutritionandMalaria-40% LOE
• Early Initiation of breastfeeding/30mins ↑
from 50% to 75% (p<0.001)
• Exclusive breastfeeding/6mo ↑ from 47% to
70% (p<0.005)
• Minimum of appropriate feeding practices(6-
23mo ↑ from 55% to 78% (p <0.001)
• Possession of LLINs ↑ from 45% to 71%
(p<0.001)
• Sleeping under LLINs ↑ from 42% to 71%)
(p<0.001)
•Source: EPICs KPC, 2015
Stunting- 2SD ↓ from
29% to 8% (p <0.001)
Underweight –2SD↓
from 43% to 11%
(p<0.001)
Source: EPICs KPC, 2015
15

16. Partnership success with MoH: the reasons
 Trust/relationship built over time
 Track record cultivated over time
 Shared goal/objectives including theory of
change
 Support with technical capacity- Country
Program, Regional and HQ
 Appreciates roles/responsibilities – including
strengths and weaknesses
16

17. Mechanisms for sustainability and scale
Sustainability
 MoH led- right from the design stage
 Transfer of knowledge and skills – ripple effect
 Existing Systems and structures strengthened
 Tools and guidelines developed to guide replication
Scale
 Already scaled up into five additional districts
 MoH sourcing funds to replicate in 5 to 10 regions of
Ghana
17

18. Challenges Encountered
 Health worker attrition- transfers
 Delayed Government subventions
 Influx of patients/clients from adjourning districts
 Conflict in the project area
18

19. Conclusions
 Partnership is key to achieving results in resource poor settings
 Partnership is a game changer in the success of community-
based MCH interventions
 Modified Motor Tricycles, Link Providers, Community Giants
scoreboard and Council of Champions are promising
community based strategies
19

20. EPPICSwasfundedbythe
United States Agencyfor InternationalDevelopment
Bureau for GlobalHealth
Officeof Health,InfectiousDisease,andNutrition
Grant No. AID-OAA-A-11-00042
20

21. THANK YOU